Novel accessory safety footswitch permitting dual control of surgical electrical diathermy: an asset in risk management in surgical training?

Introduction: Human error contributes to the majority of adverse events in the operating theatre environment. Many processes exist to limit the incidence of such adverse events. However, the role of technology and device advancement has been limited in this respect. Methods: A dual-controlled accessory electrical diathermy footswitch (abortive diathermy footswitch device or ADF) concept was developed in an attempt to improve patient safety in theatre. The activation of the ADF allows a senior surgeon to control the activation of diathermy devices by a junior surgeon by deactivating diathermy devices when the ADF footswitch is operated. Results: The ADF device was constructed as a final working and tested prototype in association with the local medical engineering department at the Cumberland Infirmary in Carlisle. The device was clinically tested during two separate theatre sessions involving five elective laparoscopic cholecystectomies. Conclusions: We demonstrated the feasibility and functionality of the ADF device and propose a role in surgical training through potentially limiting surgical errors associated with the use of electrical diathermy during training and expanding accessible surgical experience

Steal phenomenon in the lower limb: presentation of a case with osseous metastases secondary to renal cell carcinoma and review of the literature

Renal cell carcinoma is reported to have potent angiogenic activity with a high microvascular density in both primary and metastatic sites compared with other adenocarcinomas. Angiogenesis can lead to the formation of abnormal arteriovenous shunts that can, in patients with peripheral vascular disease, result in worsening of the degree of ischaemia by producing a vascular steal-like phenomena. Nevertheless, steal phenomena secondary to malignancies are extremely rare. We report a case of distal critical limb ischaemia in a patient with peripheral vascular disease exacerbated by massive arteriovenous shunting due to tibial metastases from renal cell carcinoma